Waiting for Comprehensive Waiting-Time Stats

My print column explores the challenges facing medical watchdogs who want to assess how long patients must wait to get treatments, and evaluate programs designed to reduce delays.

The challenges were highlighted by a report out earlier this year from the U.S. Department of Veterans Affairs’ Office of Inspector General, which found that waiting times for mental-health appointments were longer than the VA’s internal statistics indicated.

The VA concurred with the assessment and has outlined a plan to address the shortcomings. One of them is a 25-year-old-scheduling system of the “blue-screen, roll-and-scroll” variety, according to Michael Davies, an internist and the VA’s acting director of high reliability systems and consultation. “The plan is to replace it,” Davies said. “In the last 25 years, there’s been a lot of work in the private sector on creating some really wonderful scheduling systems. So our plan is to buy one of those scheduling systems and adapt it for use in the VA” — if the agency gets funding to do it.

Gordon P. Erspamer, a San Francisco attorney who has represented veterans who have sued the VA for delaying treatment, said that even improved software wouldn’t be immune to false data that could be reported by staff members seeking to reduce waiting times artificially. “The problem is, when you have a system as complicated as this, there always are ways to tweak the numbers to make them look better,” Erspamer said.

Mary Schohn, director of the VA’s mental-health operations, said that anyone who falsifies data would be subject to “disciplinary actions.” She added, “That’s not a culture we want to engender within the VA.”

The U.K.’s National Health Service has gotten better at measuring waiting times from a few decades ago, when it counted only how many people were waiting for a procedure and not how long they wait, according to John Appleby, chief economist of the King’s Fund, an independent health think tank in London, and visiting professor at City University London. Yet controversies persist over how to present the data, and over their accuracy.

“Especially because the government has put a lot of pressure on reducing waiting times, I suspect there’s an issue with data quality,” Appleby said, emphasizing the importance of auditing and monitoring the numbers. “You may have what you think are good measures. Whether people are filling in forms correctly is another matter.”

As hard as it is for agencies to measure their own performance, it is far harder to compare agencies or countries on the basis of how long patients wait for treatment. “It would be terrific if we could get” waiting-time data for different health-care providers, said Anne-Marie Audet, vice president for health system quality and efficiency at the Commonwealth Fund, a New York foundation that aims to improve health care. “We don’t have that yet.”

Comparing countries can be even tougher, according to Luigi Siciliani, an economist at the University of York’s Centre for Health Economics, who has worked on such international comparisons. “Patients differ in their wait, so you have a distribution of waiting times,” Siciliani said. Governments report different measures: the mean, the median, the proportion of patients waiting more than x months/weeks. The waiting time of the patients at 90th percentile.” Also, even when data are available, it’s not always clear how to combine, say, waiting times on the order of months for a hip replacement, and of hours for emergency treatments such as surgery after hip fracture. “So, aggregation is a big issue,” Siciliani said.

Appleby hasn’t found comparable numbers between the U.K. and France — nor even between England and Scotland. “I’ve tried to do this myself,” he said. “We can’t even do it within the U.K.”

About The Numbers

The Wall Street Journal examines numbers in the news, business and politics. Some numbers are flat-out wrong or biased, while others are valid and help us make informed decisions. We tell the stories behind the stats in occasional updates on this blog.